Abnormal bone development is commonly seen in children with chronic disease. However, fragility fractures in the young individual may be less common compared to older adults, which may be due to under recognition. The underlying chronic condition and medication can impact on bone turnover, modelling, bone mineral homeostasis, growth, pubertal development and muscle mass. The diagnosis and management of osteoporosis in children and adolescents with chronic disease remains contentious. In growing children, interpretation of densitometric results need to take into account the differences in stature, growth and pubertal development. There is little evidence on the predictive value of DXA BMD in children with chronic disease even when size corrected. pQCT BMD is not size dependent but the predictive value for fragility fractures in children with chronic disease is still unclear. The ISCD recommends that people up to the age of 19 years should not be diagnosed with osteoporosis solely based on low BMD by DXA and has placed a greater focus on the presence of pathological fractures, especially vertebral, such that the diagnosis of vertebral fractures alone is indicative of osteoporosis in the younger individual regardless of DXA parameters. A stronger emphasis on vertebral morphometry, is therefore, becoming more routine in the assessment of osteoporosis. With technological advances in imaging, it is also possible that identification of osteoporosis may rely on modalities that can provide a virtual bone biopsy such as high resolution MRI or CT. Optimising growth, calcium vitamin D and weight bearing exercises where possible are important measures. Ensuring normal pubertal development with timely induction of puberty in these children is often ignored. Bisphosphonates therapy should only be reserved for those children with fragility fractures, although there remains numerous unanswered questions including duration of treatment and also treatment of asymptomatic/mild vertebral compression fractures.
01 - 03 Oct 2015
European Society for Paediatric Endocrinology